A Risk for Confirmation

I love you.

She whispered it.  It was the first time she’d ever said it on her own, of her own conviction, and amid all the worry and disappointment of that moment, it was so beautiful that it made tears suddenly well up in my eyes and roll, fat and warm, down my cheeks.

The last time we’d seen the allergist, I’d asked him what I should do about lentils and peas, given that they are closely related to peanuts.  He lent back in his chair and tapped his pen to his lips as he looked at E2’s notes.  “Mmmmm…  Given her high score for peanuts, I think we’d better run RAST tests on them before you try them.”  And so he ordered bloodwork for peas, lentils, chickpeas, green beans, and navy beans.

The results came back: ever-so-slightly elevated for everything except the green beans.  This didn’t mean she actually has an allergy to any of them — confusingly, RAST tests don’t measure the actual presence or severity of an allergy, just the likelihood that the person has an allergy: the higher the RAST score, the higher the likelihood… but nothing more concrete than that.  The actual existence of the allergy and its severity can only be confirmed through an actual reaction, and testing that can be a very risky business.  So the likelihood alone is often where the matter is left and the level of caution belies the danger: on the RAST scale of 0-100, anything above even 10 is considered a High Risk warrenting serious precaution.  And yet, the allergist was telling me of patient he had with a score of 80 for eggs, who ate eggs everyday with no problem.  And here is E1, with a score of only 2 for eggs, and yet who reacted so violently to eating a piece of bell pepper that had merely been cooked with egg, that she actually had two black eyes the next day from the swelling.  Food allergies are highly unpredicatable and very, very confusing — and it’s no wonder, really, that ordinary people don’t get them.

So the allergist was not happy with E2’s results for these new foods — even though none of them were above 1 — and did not want us to run any field trials at home.  We were to try them instead in a food challenge at his clinic, under controlled conditions and watchful eyes.  I decided start with lentils, because the girl desperately needs more sources of protein in her diet …and because I do love them and have missed them terribly.

We started with a single lentil, which she refused to swallow, eyes wide and mouth hanging open so that we could see it sitting on her tongue like a miniature communion wafer.  I fished around in my bag and produced her favourite fruit stick, pulling off a small chunk and popping it into her mouth.  The open mouth widened to a grin, and the two went down together.  We waited 20 minutes and, when there was no reaction, the whole procedure was repeated with two lentils.  Again, no reaction — in fact, she was a jolly little soul, gamely dragging the stool over to the window to watch the school buses passing on the road outside, and then asking for her crayons and colouring book.  And so we continued, from two lentils to three, and then to a small clump, and then to a quarter teaspoon and a half teaspoon, each with the 20 minute wait between.  No reaction, no change in demeanor — she was sailing through this.

By the time we got to a full teaspoon — the final test — I had run out of fruit stick, but it didn’t matter.  She was comfortable with the routine by now and ate the lentils straight.  I was feeling confident about this food challenge and getting excited at the thought that we could add lentils to her diet.  As I fed her, some of them stuck to my finger and I popped it in my own mouth to lick it off.  Mmmm…  lentils…  How I love them!   I imagined lentil stew… with potatoes…  no, sweet potatoes!  And maybe lentil hotpot, with a nice mashed potato crust…  or even a corn-bread crust.  I could put lentils in the crockpot with a joint of pork…  I could even grind lentils into a flour for her bread!…

She coughed and I was jolted back into the present, my mother-instinct twinging just slightly.  But hope overcame that quickly enough:  No, no, we are sailing through this.  What a little piglet my baby is, that she eats without chewing! I sat back and picked up my knitting, and she her colouring — and coughed again.

Then after a minute or so, “Mummy!…  My eye hurts!”  She was poking at her right eye with her fingers, a silly habit she’s gotten into lately — poking her own eye and then complaining about it.  I pulled her hand away and kissed her eyelid, and then went back to my knitting, but she stopped me and crawled into my lap.   “Want to sleep…”  I looked down saw that her eye was now an angry red, and the skin around it and across the bridge of her nose had begun to swell alarmingly, and I realised immediately that it had all gone wrong.  Lentils were off the menu.  I called anxiously for the nurse.

“Yes…” she said slowly, with clear disappointment.  She’d thought we’d got there too.  “And look, two hives on her temple.”  And I spotted two more on the other cheek.  Even as we spoke, the swelling increased noticeably, the skin around her eyes rising up to smoothly meet the bridge of her nose, and her hands now covered in a hundred raised white spots.

The medical staff were calm but practiced and very focused.  Epinephrine was administered within moments, and an anti-histamine given.  E2 alternated between getting down from my lap to try to play and then climbing back up to tell me she wanted to sleep, while a trio of nurses and the doctor stood by watching her every move.   Eventually, they were satisfied that the reaction had been halted and she was on the mend.  The doctor took out E2’s notes and reviewed them.  Clearly, lentils are to be avoided at all times. Clearly.  And, given that her RAST results for peas, chickpeas, and navy beans are higher than for lentils…  there’s really no point in even testing them… And just like that, her list of allergens, instead of decreasing by one, was increased by four.  That made twelve now.  The disappointment — for the much-needed chance to widen her diet, for my personal desire to eat lentils again, and most of all for my deep-seeded need for these allergies to just go away — came like a blow to the gut.

I was given a prescription for a steroid, to combat the possibility of secondary reactions, that was to be administered tonight, tomorrow, and again the following day.  I was taken aback — could secondary reactions remain a threat for that long?  The sobering answer was yes.

When we were alone, I looked down at my daughter with a cold, black lump in my heart.  Her face…  oh, her face!  She didn’t look like my daughter.   Cheeks swelled, eyes swelled…  everything puffed up so disturbingly.  Her right eye, where she’d poked, was the worst — nearly shutting — and her eyeballs seemed to be sinking back into her skull.  You did this, I thought. This was voluntary, and you did it to her.  She didn’t have to be tested… And the guiltiest part of my mind chimed in, Anything could have happened.  You were lucky two weeks ago…  and now you go and take such a risk with her! And the most self-torturing part of my mind saw her puffed face and took my racing emotions one further, If she ever fell in the river and they pulled her out two days later, this is what she’d look like… swollen and puffy… Ridiculous, I know, but this is where a mother’s mind goes, and all the emotions from two weeks ago still so fresh and rushing back, and her allergies — my dreaded nemesis — roused to anger right before my eyes…  Oh, I was there.  I was so there!  How could I do this?  How could I do this to her?  My hands were shaking and that the lump had climbed from my heart and was now sitting firmly in back of my throat.

And that’s when she looked up at me, her swollen face plaintive and yet so lovely to me, and whispered the most beautiful thing — the confirmation I needed most at that moment…

I love you.